Medicare Beneficiary Quality Improvement Project (MBQIP)

1. Medicare Beneficiary Quality Improvement Project (MBQIP) Phase 3 Update April 2014

2. Background The Office of Rural Health Policy (ORHP) created the Medicare Beneficiary Quality Improvement Project (MBQIP) as a Flex Grant Program activity within the core area of quality improvement. • The primary goal of this project is for CAHs to implement quality improvement initiatives to improve their patient care and operations. • MBQIP provides Flex funding to support Critical Access Hospitals (CAH) with technical assistance and national benchmarks to improve health care outcomes. • CAHs opting to participate are requested to report a specific set of annual measures determined by ORHP timeline and measures and engage in quality improvement projects to benefit patient care.

3. Accountable Care This initiative takes a proactive and visionary approach to ensure CAHs are well-equipped and prepared to meet future quality legislation. • Additionally, MBQIP fulfills the Flex grant Quality Improvement (QI) objectives regarding Hospital Compare reporting, and supporting participation in various multi-hospital QI initiatives. • The main emphasis of this project is putting patients first by focusing on improving health care services, processes and administration.

4. Areas of focus and quality measures: • Phase 1: Hospital Compare pneumonia and heart failure measures • Phase 2: Hospital Compare outpatient AMI/chest pain measures, outpatient surgical measures (if applicable), and HCAHPS

5. MBQIP Goal: To implement informed quality improvement projects to improve patient care and CAH;s through data collection, leadership and support “We improve what we measure”

6. Next Steps – MBQIP phase 3 • Pharmacist CPOE or Verification of Medication Orders within 24 hours (patient safety) • E.D. Patient Transfer Communication (care transitions)

7. Medication Error An Institute of Medicine study found that medication errors injure more than 1.5 million people annually, and cost more than $3.5 billion dollars in additional hospital costs. In light of this information, rural hospitals need to implement medication safety practices, with particular focus on pharmacist staffing.

8. Overview of Pharmacy Measure Adverse drug events account for 34.2% of all hospital acquired conditions (Partnership for Patients, 2010). One solution to reducing this harm is to utilize appropriate technology to reduce errors. Evidence suggests that processing a prescription drug order through a CPOE system cuts the likelihood of error on that order by 48%. However, technology in and of itself is not the final solution. With a larger goal of increased patient safety and medication management, it is also important to have a pharmacist enter or review the medication orders because they are the medication experts.

9. “Enhanced Medication Safety” Janelle M. Mansur, JCAHO As many as 46% of medication errors occur when new orders are written at admission or discharge and up to 20% of ADEs occur as a result of poor communication at transition points (Institute for Healthcare Improvement, ihi.org) Recommendations: Improve communication, improve records, involve the pharmacist, institute double-checking

10. 10 “Key Elements” in the Medication-use system from ISMP Medication use is a complex process that comprises the sub-processes of medication prescribing, order processing, dispensing, administration, and effects monitoring. • Patient information (demographics and history) • Drug information (accurate, usable, accessible) • Communication of drug information • Drug labeling, packaging and nomenclature (LA/SA, unit dose) • Drug storage, stock, standardization, and distribution (standard times, ADCs) • Drug device acquisition, use and monitoring • Environmental factors (lighting, noise, interruptions, workload) • Staff competency and education (focused on high-alert/new meds, FMEA) • Patient education (ongoing, two-way communication) • Quality processes and risk management (systems/processes approach)

11. Getting Started…….. Does your hospital use a Computerized Pharmacy System Vendor? • If NO the CAH should consider working with a Pharmacy Vendor in the future: will NOT required to report this measure • If YES the CAH should check on the availability to generate a Pharmacist Verification Report

12. Getting Started….. A Pharmacist Verification Report, generated by your computerized pharmacy system or EHR, can provide you with all of the data elements required in order to report on the MBQIP Pharmacist CPOE/Verification of Medication Orders within 24 Hours measure.

13. Minimum Data Elements • Date for each order; • Time ordered; • Time verified (or whether “no verification required” because it was entered by the pharmacist); • Total number of orders verified or entered by pharmacist within 24 hours; and • Total number of orders entered.

14. The Pharmacist CPOE/Verification of Medication Orders within 24 Hours Measure • Numerator: Number of electronically entered medication orders for an inpatient admitted to a CAH (acute or swing-bed), verified by a pharmacist or directly entered by a pharmacist within 24 hours. • Denominator:Total number of electronically entered medication orders for inpatients admitted to a CAH (acute or swing-bed) during the reporting period.

15. Baseline Preliminary Data

16. Data Submission via Novi survey

17. Seamless Care: Safe patient transitions between facilities Ensuring appropriate and timely care beyond organizational silos is essential to transforming health care.

18. Avoiding transition of care errors • Information silos and poor communication between settings • Confusion about care management; coordination across settings • Medications Errors can occur during times of transition: upon admission, transfer, or discharge of a patient.

19. Avoiding transition of care errors Communication means more than person to person, although this is of course an enormously important. Communication also means access by all the players to mission critical clinical information. In our highly fragmented or “siloed” healthcare delivery system, this is most often the greatest barrier to effective transitions of care.

20. ED Transfer Communication Measures: – Administrative communication – Patient information – Vital signs – Medication information – Physician information – Nurse information – Procedures and tests

21. Resources

22. Population and sampling

23. Population and sampling

24. EDTC-1: (NQF # 291) Administrative Communication Does the medical record (MR) documentation indicate that administrative information was communicated to the receiving facility PRIOR TO departure? • Numerator: # of patients who have a yes or NA for both measures: nurse to nurse communication and physician to physician communication • Denominator: # All transfers from ED to another health care facility

25. EDTC-2 (NQF#294) Patient Information Does the medical record (MR) documentation indicate that the patient information was communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes or NA for all measures: name, address, age, gender, contact, insurance • Denominator: # All transfers from ED to another healthcare facility

26. EDTC-3 (NQF #292) Vital Signs Does the medical record (MR) documentation indicate that the ENTIRE vital signs record was communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes or NA for all measures: pulse, respiration, blood pressure, oxygen saturation, temperature and neurological assessment • Denominator: All transfers from ED to another healthcare facility

27. EDTC- 4 (NQF# 293) Medication Information Does the medical record (MR) documentation indicate that medication information was communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes or NA for all measures: Medications administered in ED, allergies and home medications • Denominator: All transfers from ED to another healthcare facility

28. EDTC- 5 (NQF # 295) Physician Information Does the medical record (MR) documentation indicate that physician information was communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes for all measures: history and physical and reason for transfer and/or plan of care • Denominator: All transfers from ED to another healthcare facility

29. EDTC – 6 (NQF # 296)Nursing Information Does the medical record (MR) documentation indicate nursing information communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes or NA for all measures: assessments/interventions/response, impairments, catheter, immobilization, respiratory support, oral limitations • Denominator: All transfers from ED to another healthcare facility

30. EDTC – 7 (NQF # 297)Procedures and Tests Information Does the medical record (MR) documentation indicate that procedures and tests information was communicated to the receiving facility within 60 min of departure? • Numerator: # of patients who have a yes or NA for all measures: test and procedures done and test and procedure results sent • Denominator: All transfers from ED to another healthcare facility

31. Data Submission via Novi survey

32. Abstraction Training • Complete Evaluation question related to additional training • In person at SORH • Webinar

33. Questions

34. GHA Contact Information Kathy McGowan, Vice President of Quality & Safety kmcgowan@gha.org 770-249-4519 Joyce Reid, Vice President of Community Health Connections jreid@gha.org 770-249-4545 Lisa Carhuff, Quality Improvement/Patient Safety Specialist lcarhuff@gha.org 770-249-4553